Public sector funding for contraceptives. Where do we go from here?

By Raffaela Dattler, Financing for Development Advisor, International Planned Parenthood Federation

Currently, 214 million women of reproductive age in developing regions have an unmet need for modern contraception. This means that they want to avoid pregnancy but are not using a modern contraceptive method. And needs for contraceptives will rise as more women and girls use modern methods of contraception.

The overwhelming share of contraceptives in low- and middle-income countries is financed by individual users of contraception themselves. The Reproductive Health Supplies Coalition (RHSC) estimates that 82% of total spending on contraceptives consists of women purchasing their own contraceptives from private sector providers. Domestic and donor governments only contribute a small portion of the funding. 10% of the total spending is financed by donor governments, and an even smaller share of 8% is financed by country governments, meaning a combined public sector share of contraceptives funding of 18%.

Looking at longer term trends, the RHSC’s Global Contraceptive Commodity Gap Analysis 2018 predicts a funding gap for contraceptives of USD 290 million for the year 2020 if current trends in contraceptive use continue but funding does not increase beyond current levels. If funding from donor and country governments does not increase dramatically in the coming years, most of this amount will have to be met through an increase in out-of-pocket expenditures by individual women and girls.

Health spending by national governments can be expected to rise gradually as countries’ economies grow but will not be sufficient in the short term to meet growing contraceptive needs. Donor funding will remain essential for many years to come but has been facing a downward trend.

European donor governments made important commitments for additional funding in 2017 in response to the reinstatement and expansion of the Global Gag Rule by the new US administration, yet it is too early to say whether this will bring a change in longer term funding trends. As explained in Countdown 2030 Europe’s 2016-17 tracking report, European donor funding for sexual and reproductive health and family planning had been decreasing in recent years. Current commitments will not be sufficient to meet growing needs. Funding from the US, the largest donor of family planning, had been relatively stable but is now at risk.

An increase in public sector funding will be essential to ensure more equitable access to contraception and meet growing contraceptive needs. Out-of-pocket spending is an inequitable and regressive form of health financing. A rise in out-of-pocket funding will further exacerbate inequalities and exclude those unable to pay from access to contraception.

Contraceptives are an essential investment for women and girls’ health and well-being. Governments have repeatedly affirmed their commitment to ensure universal access to family planning, including in the Sustainable Development Goals, and, most recently, at this year’s session of the Commission on the Status of Women. Yet, public sector funding falls far short of what is needed to meet contraceptive needs. If governments are serious about ensuring access to contraception for women and girls, they should step up to fill the gap.